In Cases Heavy A Reflux-ezofagita Make Or Transpleural

In cases heavy a reflux-ezofagita make or transpleural with a stomach in a chest cavity. Congenital insufficiency treat conservatively. Usually eventually there comes function normalisation . GULLET DAMAGES Gullet damages divide on internal (closed) from outside a mucous membrane and the external - necks (opened) at - getting wounds and a thorax. Internal damages of a gullet are possible during - carrying out of diagnostic and medical actions: at -, a gullet, . There are gullet wounds from within at hit in it of foreign matters (see "Gullet foreign matters"). gullet walls arise at a long finding in it of probes, from pressure or tubes. Punching of a wall of a gullet can occur at its various diseases: tumours, an ulcer, chemical burns. At an irradiation of malignant tumours of damage of a gullet arise owing to tumour disintegration. Stupid traumas of a neck, thorax and stomach can lead to infringement of a food and walls of a gullet as a result of its squeezing between a breast and bodies of vertebras Thus often mark damage of the next bodies the Straight line to a gullet trauma can occur during operations on bodies and lungs.

Bottom Possesses "unilateral - Passableness". Pressure Suffices For

Bottom possesses "unilateral - passableness". Pressure suffices For advancement of a contained gullet through penalties-diju in 4 mm hg, in a return direction movement is possible only at increase of pressure to 80 mm hg In norm pressure in the field of physiological above, than in a gullet and a bottom of a stomach, and is equal on the average 22 - 28 mm hg It are caused by the tonic reduction of circular muscular - fibres interfering zheludochno-pishchevodnomu a reflux. The - greatest value has a part physiological - which interferes with a reflux at a considerable difference of pressure in a chest and belly cavity. The normal anatomic arrangement of a gullet in relation to a diaphragm is very important for correct functioning of the closing mechanism physiological . Hit gastric - contained in a gullet is interfered also presence of "the mucous socket" in the field of pishchevodno-gastric , by an acute angle of Gisa, presence of the valve of Gubarev - folds of a mucous membrane at a junction of a gullet with a stomach, a switching reflex on at irritation of a mucous membrane department of a stomach food, etc.

At Disintegration And Knots The Macroscopical Picture Differs

At disintegration and knots the macroscopical picture differs from a picture of an ulcer cancer a little. The ulcer type of a cancer of a gullet meets approximately at 30 % of patients. In an initial stage of disease represents a small knot in thickness of a mucous membrane which quickly is exposed . The tumour grows mainly along a gullet, amazing all layers of its wall and extending on surrounding bodies and fabrics. Edges of the formed ulcer dense, the bottom is pruinose is dirty-grayish colour. Tumour early in and the remote lymph nodes. In a wall of a gullet throughout 5 - 6 sm from tumour edge often develop cancer . The infiltrativnaja form of a cancer of a gullet makes about 10 %. The tumour develops in deep layers of a mucous membrane, quickly amazes a layer and extends mainly on a gullet circle. Expanding, the tumour grasps all layers of a wall of a gullet, its gleam. On length the tumour seldom occupies more than 3 - 4 sm, is characterised by plentiful development -, slowly .

At A Congenital Short Gullet And Insufficiency There

At a congenital short gullet and insufficiency there is a reflux-ezofagit, the ulcer, and then a gullet develops , - frequent complication is the pneumonia. The diagnosis congenital anomaly of development of a gullet - establish by means of radiological research at which into a gullet gleam on thin enter 1 - 2 ml . Research allows to find out the blind end - of a gullet, level of its arrangement, extent and narrowing size, gullet expansion, presence - of the message of a gleam of a gullet with bronchial tubes or a trachea. At gullet doubling mark an additional shade with the accurate contours, adjoining a shade and pushing aside a gullet. At a short gullet it has no bends, and the stomach part is located - above a diaphragm. Insufficiency is shown zheludochno-pishchevodnym by a reflux of contrast substance during research. The big role in diagnostics of developmental anomalies - of a gullet play ezofago - and . Treatment: features of surgical treatment a - gullet are defined by its kind.

Apply : Allocate From Surrounding Fabrics To A

Apply : allocate from surrounding fabrics to a neck, make , it and take in an aperture in a gullet wall. At considerable muscular defect or an atrophy - of muscular fibres of a gullet make plastic restoration of its wall by a rag of a diaphragm, a pleura. apply only at the small sizes . after operation makes 1 - 1,5 %. GOOD-QUALITY TUMOURS AND THE GULLET Good-quality tumours of a gullet and are observed seldom. Pathological anatomy: tumours in relation to a gullet wall can be and . On a histologic - structure of a tumour divide on ( - polyps, papillomas) and (, , fibromas, , , , , , etc.). Vnutriprosvetnye tumours settle down more often in or gullet department, - in - its bottom two thirds. From good-quality tumours - of a gullet the most frequent kind is , - developing of smooth muscular fibres. The place second for frequency among good-quality - gullet formations occupy (, , ). represent the thin-walled - formations containing a light viscous liquid. The wall consists of a fibrous fabric with an impurity of smooth muscular fibres and a cartilage.

At A Thrombosis Of Venous Knot The Big

At a thrombosis of venous knot the big hypodermic vein tie up and cross at a place of its confluence of a deep vein of a hip to warn and thrombosis distribution on a deep vein of a hip. A trombirovannuju vein . Sudden infringement of earlier not coming to light hernias. On a belly - wall in typical for formation of hernias sites can remain after a birth (predsushche-stvujushchie hernial bags). More often such preprepared hernial bag in areas is brjushinno-pahovyj a shoot the Reason of sudden occurrence of a hernia and its infringement sharp increase of intrabelly pressure (- considerable physical pressure, strong cough, ) is-. In the anamnesis patients do not have instructions on signs before - existing hernias: , painful sensations in the places typical for localisation of hernias. The basic sign of suddenly arisen restrained hernias - acute pain occurrence in typical places hernias. At sudden occurrence of an acute pain in areas, in the field of the femoral channel, in a navel it is necessary - to define at inspection - of the patient at the most painful sites corresponding to hernial collars.

Small Hernias With The Narrow And Rubtsovo-changed Neck

Small hernias with the narrow and rubtsovo-changed neck of a hernial bag are restrained more often, than the big hernias. The infringement is not destiny only a hernia long existing. The hernia at occurrence can prove infringement at once. Frequency of separate kinds of hernias at adult patients with the restrained hernias: hernias - 43,5 %, postoperative hernias - 19,2 %, umbilical hernias - 16,9 %, femoral hernias - 16 %, hernias of a white line of a stomach - 4,4 %. Any body can be restrained, the small intestine and the big epiploon are more often restrained. On the occurrence mechanism distinguish , and mixed, or combined, infringement. The Elastichesky infringement occurs at the moment of sudden - increase of intrabelly pressure at physical activity, cough, , etc. Thus there comes a restretching of hernial gate therefore in a hernial bag leaves more than usually an internal. Returning of hernial gate in a former condition leads to infringement of contents of a hernia. At infringement the left.

Among Other Symptoms Gullet Narrowings Are Often Observed

Among other symptoms gullet narrowings are often observed pains of a breast at the food intake, raised , an eructation, a heartburn. As a result of food infringement the exhaustion of patients progresses. To one of the most frequent complications of cicatricial narrowing of a gullet is a gullet food at which ( urgent medical aid is necessary for extraction of a food lump). - Owing to food and it chronic inflammatory diseases of bronchial tubes and lungs often develop - in respiratory ways. - As a result of longitudinal cicatricial shortening of a gullet probably formation or hernia increase diaphragm apertures. Development of a cancer tumour in area is possible. At patients with stenoses more often, than at healthy people, punching of a gullet is observed during tool researches. The diagnosis of a stenosis of a gullet is confirmed with the data of the anamnesis and radiological research with liquid and dense contrast - substance. Gullet narrowings have the form, the relief of a mucous membrane in the field of narrowing is absent, is not defined.

Borders Of A Femoral Ring: From Above -

Borders of a femoral ring: from above - a sheaf; from below - a comb bones; outside - a femoral vein; to the middle - a sheaf. In normal conditions of the femoral channel does not exist. It is formed at formation of a femoral hernia. The oval pole on wide hips is an external aperture of the femoral channel. The most frequent form of a hernia is the hernia leaving a belly cavity through a femoral ring. The hernial bag advances ahead of itself and a lymph node of Pirogova - Rozenmjullera. Leaving from under sheaves, the hernia settles down in an oval pole from a femoral vein. The hernial bag is covered here fatty , superficial and a skin. Less often the femoral hernia leaves between a femoral artery and a vein. Hernias of a vascular lacuna can be identified only during operation. Sometimes the - hernia leaves through defect sheaves. Occasionally observe hernias of a muscular lacuna, usually in a zone of passage of a femoral nerve. This hernia owing to its characteristic arrangement a vascular bunch can be distinguished before operation.

At Germination By A Tumour Of Returnable Nerves

At germination by a tumour of returnable nerves at patients hoarseness of a voice, defeat of knots - of a sympathetic nerve develops-, the syndrome of Gornera is shown. a wandering - nerve can cause a bradycardia, fits of coughing, vomiting-. Germination by a tumour a nerve is accompanied - by a diaphragm paralysis on the corresponding party, and a humeral - texture - a pain, , and then a paralysis of the top finiteness. Transition of a tumour to a throat is accompanied by change - of sounding of a voice, occurrence of a short wind and breath. At (germination) of a trachea and bronchial tubes there is a cough, a short wind (at 7,2 %). Formation pishchevodno-trahealnogo or a pishchevodno-bronchial fistula is shown by cough at - liquid reception-. This complication usually comes to an end with development of a pneumonia, an abscess or a lung gangrene. Owing to transition of an infection from a gullet can develop , , -. At destruction by a tumour of a wall of a large vessel there are massive bleedings.

For A Cancer Progressing Increase Of Impassability Of

For a cancer progressing increase of impassability of a gullet which at one patients develops quickly, at others - slowly (during 1 1/2 - 2 years) is characteristic. Infringement of passableness of a gullet is connected not only with narrowing of its gleam by a tumour, but can be caused development pe-rifokalnogo inflammations, occurrence of a spasm of a gullet at defeat by a tumour nervous textures. More often the spastic phenomena mark at tumours. In a - disease initial stage arises at proglaty-vanii the dense or not enough chewed food. Patients feel as though its "sticking" to a wall of a gullet or a time - delay at certain level. The water drink usually eliminates - these phenomena. Even well chewed food further ceases to pass, and patients are compelled to accept semi-fluid - and liquid food, becomes a constant and arises even at the liquid use. Sometimes after the proof period there is an improvement of passableness of food on a gullet, connected with tumour disintegration. To occurrence can precede appearing at firm food of sensation of a foreign matter in a - gullet, feeling "" behind a breast, morbidity at defeat level.

Edges Of Hernial Gate Firm Owing To Development

Edges of hernial gate firm owing to development of a dense cicatricial fabric. External covers of a postoperative hernia are presented by a cicatricial fabric, is intimate with a hernial bag, or a skin with hypodermic and a postoperative hem in the middle. - Muscles adjoining - to hernial collars can also - be changed-. The hernial bag quite often happens multichamber, and a hernia . Recognition of postoperative hernias does not represent - difficulties. Detection in a postoperative hem hernial , appearing at , cough, is sufficient for diagnosis statement. For definition of the body which is in a hernial bag, make radiological research of a gastroenteric path. Treatment: the surgical. At the big hernias operation presents difficulties because of unions of contents of a hernia with a - hernial bag and presence of major defects of a belly wall. At small hernias probably closing of defect at the expense of soft fabrics. During operations concerning the big postoperative - hernias apply methods , and methods of the combined plasticity of defects of a belly wall.

It Is Necessary To Exclude Also A Gullet

It is necessary to exclude also a gullet pushing off from the outside tumours - back , an intrachest craw, the aortas, the increased lymph nodes, filled . The important radiological sign a gullet - is its displacement Even substantial growth of the next bodies - long time does not cause as smeshchae-most a gullet in friable connecting it is great enough. and infringement of passableness of a gullet can be caused (cicatricial change - ), arising after inflammatory - diseases of lungs and lymph nodes . In the anamnesis these patients have instructions on sharp and chronic diseases - of lungs, causeless rises in temperature of a body. at them develops quickly. At radiological research - contours of the narrowed site of a gullet equal, are more rare - wavy-, the mucous membrane relief is kept, the gullet wall at swallowing and breath is not displaced, round a gullet the shade condensed is visible. At a gullet tuberculosis a clinical and radiological picture of disease can have a strong likeness with displays of a cancer of a gullet.

Clinic And Diagnostics: The Most Frequent Complaint Is

Clinic and diagnostics: the most frequent complaint is the heartburn or sensation of burning in areas, behind a breast or on a course of all gullet; after a heartburn there is a - pain. Symptoms arise or amplify at a trunk inclination forward (a symptom " a boot"), are caused by influence on the inflamed mucous membrane of a gullet - of gastric or intestinal juice with bile. Attacks of pains can be connected with strong spastic reductions of a gullet that confirms radiological and ezofagoto-nokimograficheskoe research. Pains can in a back-, between shovels, in a neck, jaws, upwards on a gullet, in the left half of thorax. It is almost always marked . At at night can occur - food weights and gastric juice in respiratory ways that causes strong cough. Disease is connected with insufficiency of the switching mechanism physiological and consequently the conditions promoting return receipt of contents from a stomach in a gullet (a prone position, a trunk inclination forward), cause occurrence of the basic symptoms.

Survey Of The Patient In Vertical Position Gives

Survey of the patient in vertical position gives representation - about asymmetry areas. At presence a belly wall it is possible to define the sizes and the hernia form At define a surface, a consistence hernial -, intestines rumbling, at - a sound (, ). Manual research external from the channel make in horizontal position of the patient after reposition of a contained hernial bag. The doctor a forefinger, a skin , gets to a superficial aperture the channel, . inside and a little above from In norm the superficial aperture the channel at men passes a finger-tip. At easing of a back wall the channel it is possible to get freely a finger-tip for a horizontal branch bones that it is not possible to make at well expressed back wall formed cross-section of a stomach. Being in the channel the finger of the doctor at a tussiculation of the patient feels - transfer pushes of an internal - a symptom a push. Both investigate the channel. It is necessary to investigate bodies ( seed , and its appendage).